Learning Objective #1: The learner will be able to understand that serum drug concentration monitoring in sampling techniques and knowledge is further benefit for patient care.

Learning Objective #2: The learner will be able to understand of Patient serum drug concentration monitoring, risk analysis and proposed improvements.

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In 1998 The American Pharmacists Association reported that inappropriate drug use can lead to adverse drug reaction and lethal side effects. Its studies found that 6.7% of hospitalized patients were administered potentially fatal drug concentrations. Domestic studies also support this claim, further indicating that inappropriate serum drug concentration monitoring can lead to increased side effects and possibly lethal reactions. The survey and observational study was conducted at a single tertiary medical center, from April to August 31st 2007. It utilized the health care failure mode and effect analysis to assess the existing serum drug concentration monitoring protocol and risk assessment amongst the nursing staff. A total of 88 questionnaires were distributed and 80 (90.90% of total) forms were collected. The data analysis by the SPSS10.0,This investigation proved that serum drug concentration monitoring is essential for patient care. Furthermore it noted that the majority of the nursing stuff were lacking in knowledge regarding drug concentration issues and proper sampling techniques. Related topic lectures, further educational seminars, reminder notes, tables and telephone hotlines were then instigated to ameliorate these problems. Result : Follow- up survey analysis showed that overall topic knowledge had improved, from 65.33% to 86.51%. Secondly, inaccurate monitoring sampling techniques had decreased, from 0.068% to 0.00%. This article suggests additional nursing staff education and persistent monitoring is needed to further benefit overall patient care.